In an adult with hyperkalaemia, how often should Lokelma (sodium zirconium cyclosilicate) be administered?

Lokelma Administration Frequency

For initial treatment of hyperkalemia, Lokelma is administered 10 g three times daily for up to 48 hours; after achieving normokalaemia, the standard maintenance dose is 10 g once daily. 1

Initial Treatment Phase (Correction Phase)

• Administer 10 g three times daily for up to 48 hours to rapidly lower serum potassium levels in adults with hyperkalemia 1, 2
• This regimen reduces serum potassium by approximately 1.1 mEq/L within 48 hours, with most patients achieving normokalaemia (3.5–5.0 mmol/L) during this period 3, 2
• The onset of potassium reduction begins within 1 hour of the first dose, with median time to normalization of 2.2 hours 2, 4
• By 24 hours, 84% of patients achieve normokalaemia, and 98% achieve it by 48 hours 2

Maintenance Phase (Long-Term Management)

• After achieving normokalaemia, switch to 10 g once daily as the standard maintenance dose 1, 2
• The maintenance dose range is 5 g every other day to 15 g once daily, adjusted based on serum potassium levels and desired target range 1
• Titrate the dose in 5 g increments at intervals of 1 week or longer based on serum potassium monitoring 1
• In clinical trials, 90% of patients maintained normokalaemia on 10 g daily dosing over 28 days 5
• Long-term efficacy has been demonstrated for up to 12 months, with 88% of patients maintaining mean serum potassium ≤5.1 mEq/L throughout the study period 3, 6

Special Population: Chronic Hemodialysis Patients

• Administer Lokelma only on non-dialysis days in patients on chronic hemodialysis 1
• The recommended starting dose is 5 g once daily on non-dialysis days 1
• For patients with serum potassium >6.5 mEq/L, consider a starting dose of 10 g once daily on non-dialysis days 1
• Adjust the dose based on pre-dialysis serum potassium values after the long inter-dialytic interval 1
• The maintenance dose range is 5 g to 15 g once daily on non-dialysis days 1

Monitoring Protocol

• Check serum potassium within 1 week after initiating therapy or any dose adjustment during the maintenance phase 3, 1
• Decrease the dose or discontinue if serum potassium falls below the desired target range 1
• Monitor for edema, particularly with higher doses (6% incidence with 10 g daily, 14% with 15 g daily) 3, 2
• Watch for hypokalemia, though the incidence is low (10% with 10 g dose, 11% with 15 g dose in clinical trials) 2

Administration Instructions

• Administer other oral medications at least 2 hours before or 2 hours after Lokelma to avoid reduced absorption 1
• Empty the entire contents of the packet(s) into approximately 3 tablespoons of water, stir well, and drink immediately 1
• If powder remains, add more water, stir, and drink until no powder remains to ensure the entire dose is taken 1

Critical Clinical Considerations

• Lokelma is not recommended for emergency treatment of life-threatening hyperkalemia due to its 1–2 hour onset; use insulin/glucose, beta-agonists, or dialysis first for acute emergencies 3
• Each 10 g dose contains 1200 mg of sodium during the correction phase and 400–1200 mg sodium daily during maintenance, so monitor for edema in patients who should restrict sodium intake 3
• The most common adverse effects are gastrointestinal symptoms (constipation, diarrhea, nausea), which are generally mild to moderate 3